Customer Service Healthcare Representative
On-siteWashington, District of Columbia, United States or Washington, United States
Job Summary
Provide guidance on provider networks, referrals, and pre-authorizations while troubleshooting billing, payments, and coverage issues. Ensure HIPAA compliance when handling sensitive member information and collaborate with internal departments to resolve complex concerns. Maintain accurate records of interactions in CRM systems and meet performance metrics for response time, resolution rate, and customer satisfaction. Stay updated on policies, state regulations, and healthcare industry changes. This role requires working flexible shifts, including weekends and holidays, with previous customer service experience in healthcare or insurance preferred.
Required Qualifications
- Must be 18 years or older
- High school diploma or equivalent
- Previous customer service experience, preferably in healthcare or insurance
- Strong verbal and written communication skills
- Independent decision-making and problem-solving skills with the ability to remain calm under pressure
- Ability to handle high call/chat/email volumes effectively
- Proficiency in computer applications, including CRM and customer support platforms
- Ability to work flexible shifts, including weekends and holidays
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